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Obamacare looking healthy for 2019, despite attacks

More insurers. Only a few huge price hikes. Even some premium decreases.

This is what Obamacare looks like for 2019.

Despite President Donald Trump and Congressional Republicans' attempts to wound the landmark health reform law, Obamacare is surviving -- and even growing stronger.

The landscape is markedly different than at this time a year ago, when insurers were fleeing the marketplace or hiking rates to combat all the GOP-fueled uncertainty surrounding the Affordable Care Act.

Yet, questions still abound for 2019.

Next year will be the first time that Americans will not have to pay the penalty for being uninsured since the Obamacare insurance exchanges opened in 2014. Congress eliminated the individual mandate penalty as part of last year's tax overhaul.

Also, the Trump administration is making it easier for people to buy alternative policies
that will likely be less expensive, but won't provide the same benefits, particularly for those with pre-existing conditions.

All these changes are expected to siphon younger and healthier enrollees out of the exchanges, experts say. That could prompt insurers to raise rates for the older and sicker folks who remain in Obamacare policies.

Plus, Obamacare is facing new threats from the nation's judicial system. The US Senate is wrapping up Supreme Court confirmation hearings for Judge Brett Kavanaugh
, who Obamacare supporters fear would vote to overturn the health reform law. And a US District Court judge in Texas this week heard arguments in a case that seeks to bring down the Affordable Care Act
by having major portions or the entire law declared unconstitutional.

So far, however, many insurers are keeping price increases in check. Several have even said they would have raised rates even less -- or decreased them -- if Congress hadn't eliminated the individual mandate penalty.

In Kansas, insurers requested rate increases of slightly less than 6%, on average, which is significantly lower than in past years, said Insurance Commissioner Ken Selzer.

"We again have a competitive market in Kansas for 2019 with every county having plan choices available from multiple insurance carriers," he said.

Blue Cross and Blue Shield of North Carolina is cutting its rates by 4.1%, on average. This marks the insurer's first premium reduction since it entered the state's individual market more than 25 years ago. It attributed the decrease to new deals with health care providers to keep costs in check.

Still "to keep driving premiums down, we need more market stability and more certainty from Washington," said Patrick Conway, CEO of Blue Cross North Carolina.

In Tennessee, where rates had risen more than 176% since the exchanges opened in 2014, two insurers are planning price breaks for next year. BlueCross BlueShield of Tennessee, the state's largest carrier, filed for a 15% cut in premiums, while Cigna is requesting a nearly 13% decrease. A third insurer, Oscar Health, asked for a 7.3% increase.

Overall, insurers have requested or received premium increases of 3.6%, on average, across 47 states and Washington, D.C., for next year, according to an analysis
by the Associated Press and Avalere Health, released Friday.That compares to a 30% increase for 2018.

"This year, double-digit increases are by far the exception," said Katherine Hempstead, senior policy adviser at the Robert Wood Johnson Foundation. "Last year, they were the rule."

Insurers are also returning to the exchanges
after several years of exits. Tennessee, which had 11 insurers in 2016 but only three this year, will have five next year.

Anthem, a major player in the individual market that pulled out of several states last year, is expanding its presence in Kentucky and Virginia and returning to Maine for 2019. Oscar is entering Florida, Arizona and Michigan, while broadening its reach in Ohio, Tennessee and Texas.

A little more than one-third of counties examined by the Robert Wood Johnson Foundation will have more insurers than last year, said Hempstead, who looked at half of the nation's states. There will be very few reductions in coverage.

"Those carriers that stayed in the market have figured out how to make money," Hempstead said. "Looking at that has attracted some interest from others."